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Year 5/6 > Medicine: Rheum > Flashcards

Medicine: Rheum Flashcards

1
Q

What are the key parts to a rheum hx?

A

PC - joint pain, stiffness, swelling

SHx - functionality, job, driver, smoking, drug compliance

SRV - skin, eyes, renal, constitutional, fatigue

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2
Q

What does the timing of the stiffness indicate?

A

Early morning, within ~half an hr, inflammatory

Worsens throughout the day infers more degenerative

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3
Q

What is the DAS28?

A

Disease Activity Score - 28 Joints

Number swollen and tender, inflam marker, global assessment

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4
Q

How does the DAS28 score translate to disease activity?

A

> 5.1 Active
<3.2 Low
<2.6 Remission

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5
Q

Which is arguably the most important aspect of rheum exams?

A

Looking

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6
Q

Talk through the hand exam

A

LOOK
Elbows, hands, skin, nails, palms, finger pulps

FEEL
Pulses, muscle bulk, snuffbox, tendon thickening, sensation, temp, squeeze MCPs then individually each MCP PIP DIP and wrists, sensation

MOVE
Active prayer and reverse, passive wrist flexion/extension, extend fingers, splay, push hands down, thumb, fists

FUNCTION
Power grip, pincer grip, pick up small object/do up button/hold pen, Tinel’s, Phalen’s, Froment’s, Finkelstein’s

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7
Q

What are you looking for in the elbows?

A

Psoriatic plaques, rheumatoid nodules, olecranon bursa, gout tophi

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8
Q

Where else should you look if you’re suspicious of gout?

A

The pinna of the ear

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9
Q

What are your looking for in the hands?

A

Hands: swelling, loss of alignment, muscle wasting, scars, symmetry

Skin/nails: pitting, ridging, nail fold vasculitis

Palms/finger pulps: palmar erythema and scars from carpal tunnel release

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10
Q

Boutonniere deformity @ PIP and DIP

A

Flexion @ PIP

Extension @ DIP

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11
Q

Swan neck deformity @ PIP and DIP

A

Extension @ PIP

Flexion @ DIP

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12
Q

What do nail signs suggest?

A

Clubbing - cardio, resp, gastro

Pitting - psoriasis

Koilinychia - iron def

Leukonychia - liver disease

Splinters - vasculitis

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13
Q

How do you test sensation in the hands?

A

Median - over thenar eminence

Ulnar - over hypothenar eminence

Radial - thumb and index webspace

Plus can do C678 dermatomes

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14
Q

Describe Phalen’s test

A

If you suspect carpal tunnel, perform reverse prayer for 60s or squeeze wrist and force into flexion for 30s, pos if any tingling/numbness

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15
Q

SEs of colchicine

A

Nausea, vomiting, diarrhoea

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16
Q

Which three qs do you always ask at the start of the GALS screen?

A

Pain and stiffness, dressing, stairs

  1. Do you have any pain or stiffness in your muscles, joints or back?
  2. Can you dress yourself completely w/o any difficulty?
  3. Can you walk up and down the stairs w/o any difficulty?
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17
Q

GALS: What are you looking for in the gait?

A

Smoothness, symmetry, ability to turn quickly

NB: heal to toe and tip toe walking is more neuro looking for cerebellum problems

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18
Q

GALS: What are you looking for during inspection?

-From Behind-

A

Trapezius and gluteal muscle bulk size and symmetry

Spinal alignment

Level iliac crests

Popliteal obv swelling

Hindfoot abnormalities

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19
Q

GALS: What are you looking for in the spine?

-From Side-

A

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

Schober’s test

Knee flexion/hyperextension

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20
Q

What does Schober’s test assess?

A

Lumbar flexion by placing two fingers on adjacent vertebrae and asking the pt to touch their toes and come back up again

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21
Q

GALS: What are you looking for in the arms?

-From Front-

A

Muscle bulk and symmetry

Elbow extension in anatomical position

Cervical spine lateral flexion each side

Open jaw wide and move side to side

Elbow flexion w hands behind head

Crude hand exam inc fists, thumb to each finger, power grip and squeeze across MCPs

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22
Q

What is TMJ pain often a/w?

A

RA and inflam joint disease

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23
Q

What else does putting hands behind head w elbow back test?

A

Humeral movement and functionality

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24
Q

GALS: What are you looking for in the legs?

-Lying Down-

A

Passive knee flexion, hip flexion, hip internal rotation

Patellar tap looking for a large effusion

Sweep/bulge test looking for smaller effusions

Crude foot exam inc callus formation and squeeze across MTPs

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25
Q

Which rotation at the hip do you perform as part of the GALS screen?

A

Internal

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26
Q

How do you record an unremarkable GALS in the notes?

A

GALS: NAD

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27
Q

What does REMS stand for?

A

Regional Examination of the Musculoskeletal System

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28
Q

Hx for Ank Spond

A

Fatigue, lower back stiffness > pain, early morning and after sitting then relieved by activity

Plus quick SRV

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29
Q

What should you do if you lose your thought in a hx?

A

Summarise

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30
Q

Ix for Ank Spond

A

Bloods inc HLA-B27, xray, MRI

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31
Q

What would you find on MRI of ank spond?

A

Sacroiliitis

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32
Q

Mx for Ank Spond

A

Early intervention w physio and NSAIDs then consider steroids and biologicals

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33
Q

What is the ACR and EULAR 2010 RA diagnostic cut off?

A

6 points to dx RA & <6 labelled as undifferentiated inflammatory arthritis

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34
Q

Outline the rheumatoid arthritis ACR and EULAR 2010 classification criteria

A

Tbc

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35
Q

Felty’s Triad

A

RA, Splenomegaly, Neutropenia

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36
Q

Hand Hx

A

Hand dominance, weakness, tingling, pregnant, rheumatoid, prev surgery

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37
Q

RFs for Gout

A 
Age
Male
Injury
CVD
HTN
CKD
Diabetes
Obesity
Thiazide
Lead
FHx
Diet
Alcohol
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38
Q

Mx of Gout vs Pseudogout

A

Bloods: FBC, U+Es, Uric Acid

Acute Tx: NSAIDs, Colchicine, Steroids

Chronic Tx: lose wt, inc water dec alcoholic and fizzy drinks, low purine diet + allopurinol w initial NSAID cover if gout>pseudo

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39
Q

How can SLE be diagnosed?

A

> =4

Serositis
Oral Ulcer
Arthritis
Photosensitivity

Blood Disorder
Renal Disorder
Anti Nuclear Abs
Immuno Disorder
Neuro Disorder

Malar Rash
Discoid Rash

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40
Q

What is Hatchet sign?

A

The limited erosion of the lateral aspect of the humeral head found in ank spond

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41
Q

What do the lumbricals of the hands do?

A

Flex at MCP + Extend at IPJ

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42
Q

Which inflammatory conditions are more common in males>females? (2)

A

PSC + Ank Spond

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43
Q

What do OA hands look like?

A

Heberden’s @ DIP
Bouchard’s @ PIP
Base of Thumb Squaring

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44
Q

Psoriatic Arthritis

A

Psoriasis
Nail Changes: onycholysis, pitting, subungual hyperkeratosis, discolouration

Small joint arthritis involving both the PIP and DIP joints

Dactylitis

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45
Q

Which antibody is most specific for RA?

A

Anti-CCP

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46
Q

Ix for RA

A

O/e: tender, stiff, swollen, number and type of joint involved, DIP sparing

Bloods: acute phase markers, anti-CCP, rheumatoid factor

Imaging: early disease may show synovitis on US/MRI but x-rays monitor joint damage over time - loss of joint space, bony erosions, periarticular osteopenia, joint deformities

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47
Q

Mx of RA

A
  1. Analgesics
  2. NSAIDS
  3. Steroids
  4. DMARDs - conventional (methotrexate), biological (anti-TNF), targeted (JAK inhibitors)

Conventional:
Methotrexate
Sulphasalazine
Hydroxychloroquine

Biological:
Anti-TNF
IL-6 Receptor - toclizumab, sarilumab
Anti-CD20 (target B cells) - rituximab
CTLA4-Ig (targets T cell activation) - abatacept

Targeted:
JAK Inhibitors

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48
Q

Anti-TNF

A 
Etanercept
Adalimumab
Certolizumab
Golimumab
Infliximab
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49
Q

JAK Inhibitors

A

Tofacitinib
Baricitinib
Upadacitinib
Filgotinib

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50
Q

What is characteristic of the spondyloarthritides?

A 
HLA B27
Arthritis
Sacroiliitis
Iritis
Dactylitis
Enthesitis
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51
Q

What is the ASAS classification of axial spondyloarthritis?

A

Aged <45 w at least 3mnths of back pain

Must have sacroiliitis on imaging plus one other feature or HLA B27 plus two other features

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52
Q

What drug won’t work for axial spondyloarthritis?

A

Conventional DMARDs

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53
Q

Mx of Ank Spond

A
  1. Analgesics
  2. NSAIDS
  3. DMARDs - biological (anti-TNF and IL-17 blocker) + targeted (JAK inhibitors)
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54
Q

What is the ASAS classification of peripheral spondyloarthritis?

A

Aged <45 w peripheral features only

Must have arthritis/enthesitis/dactylitis plus one/two other features

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55
Q

Psoriatic Arthritis X-ray

A

Loss of joint space

Erosions

Bony proliferation

Osteolysis

Spurs

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56
Q

Mx of Psoriatic Arthritis

A
  1. Analgesics
  2. NSAIDS
  3. DMARDs - conventional (methotrexate), biological (anti-TNFα or anti-IL17), targeted (JAK inhibitor or apremilast)
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57
Q

Which organisms cause reactive arthritis?

A

GU: chlamydia

GI: shigella, salmonella, yersinia, campylobacter, e coli

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58
Q

SLE

A

Mild: rash, arthritis, lymphadenopathy

Mod: pleurisy, pericarditis, cytopenia

Sev: renal and CNS involvement

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59
Q

What are the SLICC criteria for diagnosing SLE?

A

Must have biopsy proven lupus nephritis w positive ANA or dsDNA

OR

Must have four criteria including at least one clinical and one immunological

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60
Q

Mx of SLE

A

Minimise the use of prednisolone and add steroid sparing agents: hydroxychloroquine for skin and joint involvement, azathioprine, mycophenolate, rituximab, tacrolimus, cyclophosphamide for sev disease

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61
Q

Ix of CTD

A

Screen with ANA then dsDNA, ENA, cytoplasmic to confirm dx

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62
Q

How do you monitor treatment efficacy in SLE?

A

ESR
dsDNA
C3/C4

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63
Q

Primary Sjogren’s Syndrome

A

It involves inflam destruction of exocrine glands particularly the lacrimal and salivary

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64
Q

What should you counsel a young female with anti-Ro or anti-La abs about?

A

If she does get pregnant they can cross the placenta and cause fetal heart block

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65
Q

Where does the skin involvement in CREST not progress beyond?

A

Forearms/Calves

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66
Q

Comps of LCSS

A

Pulmonary HTN

Plus: ILD, renal crisis, extensive gut disease (all more common in DCSS)

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67
Q

Ix for Scleroderma

A

Dx: ANA, anti-centromere for LCSS, anti-scl70 for DCSS

Comps: ECG/echo, CXR/CT, U+Es/urinalysis

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68
Q

Mx of Raynaud’s

A

Consrv: avoid cold environments, keep whole body warm, gloves

Medical: nifedipine, sildenafil, IV iloprost

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69
Q

Ix for Dermatomyositis

A 
CK
ANA
Myositis Ab Panel
MRI Involved Muscle
Electromyogram
Muscle Biopsy
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70
Q

Ix for GCA

A

Acute Inflam Markers
Temporal Artery US +/- Biopsy
FDG PET Scan

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71
Q

Mx of GCA

A

Immediate PO Prednisolone 40-60mg 4w + urgent ophthal review

If visual sx: add IV methylprednisolone 500mg

If persistent/relapsing disease: add an IL6 blocker

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72
Q

ANCA

A

cANCA: a/w abs to proteinase 3 occurring in pts w GPA

pANCA: a/w abs to myeloperoxidase occurring in pts w eGPA and microscopic polyangiitis

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73
Q

Ddx of Purpuric Rash

A

Infection: meningococcal septicaemia + haemorrhagic fevers

Inflammation: HSP

Thrombocytopenia: ITP

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74
Q

What could you give pts who are unable to tolerate wkly alendronate?

A

Annual IV Zoledronate

OR

Biannual S/C Denosumab

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75
Q

How many wks after an acute attack of gout should you wait before starting allopurinol?

A

3wks

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76
Q

What are the RFs for CPPD?

A

Inc Age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia

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77
Q

What is the typical pt w PMR?

A

Elderly pt w bilateral morning stiffness in shoulder and hip girdles + pain - weakness but pain makes raising arms, getting out of a chair and going up the stairs difficult

78
Q

Ix for PMR

A

Raised ESR/CRP

Plus rule out ddx: RA - anti-CCP; Myositis - CK; Malignancy - FLAWS, bloods, serum electrophoresis, urinary bence jones protein, CT CAP

79
Q

Mx of PMR

A

Start prednisolone 15mg/d PO and expect a dramatic response within 1wk then wean 1mg/mnth

80
Q

What is the most specific antibody for SLE?

A

Anti-Smith

Anti-dsDNA

81
Q

Tx of Raynaud’s Syndrome

A 
Nifedipine
Primrose Oil
Sildenafil
Epoprostenol
Sympathectomy
82
Q

What ab is a/w drug-induced SLE?

A

Antihistone

83
Q

What should be performed annually in pts w diffuse systemic sclerosis? (2)

A

Echo + Spirometry

84
Q

What ab is a/w mixed CTD?

A

Anti-U1-RNP

85
Q

Which NSAID carries the lowest cardiovascular risk?

86
Q

Ix for Myositis

A

Inc muscle enzymes in plasma ie ALT AST LDH CK and aldolase; EMG shows fibrillation potentials; MRI shows oedema if acute; autoabs anti-M2 and anti-Jo1 if acute and ILD; muscle biopsy confirms the dx

87
Q

Tx of Myositis

A

Prednisolone

If resistant: immunosuppressives/cytotoxics

If skin disease: hydroxychloroquine/topical tacrolimus

88
Q

Ddx of DIP Involvement

A

OA + Psoriatic Arthritis

89
Q

What are the three best tests for monitoring activity in SLE?

A

Anti-dsDNA
Complement
ESR

90
Q

Which DMARD causes azoospermia?

A

Sulfasalazine

91
Q

Which DMARD causes retinopathy?

A

Hydroxychloroquine

92
Q

Why may a pt w polymyalgia rheumatica appear weak?

A

Pain inhibition > true weakness of limb girdles

93
Q

What are the Gell and Coombs classification of hypersensitivity?

A

I - Anaphylactic IgE
II - Cell Bound IgG/M
III - Immune Complex
IV - Delayed T Cell

94
Q

What is the defect in Marfan’s syndrome?

A

FBN1 gene, chr15, fibrillin-1

95
Q

What might dilation of the aortic sinuses lead to?

A

Aortic Aneurysm

96
Q

What cardiac features can be found in Marfans pts?

A

Aortic aneurysm, dissection, regurg + mitral valve prolpase therefore require annual echo +/- meds

97
Q

Inf MI + complete heart block tx

A

Consrv is asx and haem stable or w atropine if also chest pain, syncope, HF or shock

98
Q

Ant MI + complete heart block tx

99
Q

Ix to rule out and confirm dx of SLE

A

Rule out: ANA has the highest sensitivity

Confirm dx: anti-dsDNA has the highest specificity

100
Q

What should be screened for following dx of dermatomyositis?

A

Underlying malignancy typically ovarian, breast, lung

101
Q

What are the skin features of dermatomyositis?

A

Photosensitive, heliotrope rash in periorbital region, Gottrons papules over dorsum of hands

102
Q

cANCA vs pANCA

A

cANCA: targets PR3 + pos for GPA

pANCA: targets MPO + pos for eGPA, microscopic polyangiitis, UC/PSC

103
Q

Mx of ANCA associated vasculitis

A

MDT: rheum, resp, renal

104
Q

Ix + Mx for GCA

A

Ix: inflam markers + temporal artery biopsy

Tx: high dose pred + urgent same day ophthal review

105
Q

Typical demographic of ank spond pt

A

Young Male

106
Q

Ix + Mx for Ank Spond

A

Ix: inflam markers and HLA-B27, spirometry, imaging

Mx: encourage reg exercise, physio, NSAIDs, DMARDs if peripheral joint involvement, anti-TNF if persistently high disease activity despite conventional tx

107
Q

What does the x-ray of sacroiliac joints show in ank spond pts?

A

May be normal early in disease

Sacroiliitis, sclerosis, subchondral erosions

Plus squaring of lumbar vertebrae, syndesmophytes, bamboo spine (late and uncommon)

108
Q

What does MRI show in ank spond pts?

A

Done if neg x-ray but still high suspicion which will show signs of early inflam eg BM oedema

109
Q

What is the dagger sign of a bamboo spine?

A

Single central radiodense line on x-ray related to ossification of supraspinous and interspinous ligaments

110
Q

What causes syndesmophytes?

A

Ossification of outer fibres of annulus fibrosus

111
Q

How long should either sex wait following methotrexate tx before conceiving?

112
Q

How often is methotrexate taken?

113
Q

What should be co-prescribed alongside methotrexate and when should it be take?

A

Once wkly folic acid 5mg taken >24hrs after each methotrexate dose

114
Q

Which pts <60yrs get pseudogout?

A

Underlying risk factor: haemochromatosis, Wilson’s disease, acromegaly, hyperparathyroidism, low Mg, low phosphate

115
Q

What is antisynthetase syndrome?

A

A subtype of dermatomyositis: myositis + ILD +/- hand sx

116
Q

Which abs are pos in antisynthetase syndrome?

117
Q

What are the bone profile blood tests results in pts w osteogenesis imperfecta?

A

Normal: Ca, PO4, PTH, ALP

118
Q

What does hyperCa in the absence of elevated PTH suggest?

A

1° Malignancy or Sarcoidosis

119
Q

What hx is suggestive of acute reactive arthritis?

A

Can’t see, pee or bend the knee

120
Q

Def of reactive arthritis + most commonly associated organisms

A

Arthritis following an infection where the organism cannot be recovered from the joint

Post-Dysenteric: shigella, salmonella, yersinia, campylobacter - M=F

Post-STI: chlamydia trachomatis - M>F

121
Q

How do renal comps of systemic sclerosis px + tx?

A

HTN + AKI +/- MAHA -> ACEi

122
Q

What is labetalol commonly used for?

A

To acutely lower BP in haemorrhagic strokes

123
Q

Preventing pathological fractures: bisphosphonates vs denosumab

A

Whilst alendronate is first line if eGFR <30 then denosumab is preferred

124
Q

Denosumab: Dose + SEs

A

Dose: S/C 60mg 6mnthly or 120mg 4wkly to prevent skeletal-related events in adults w mets from solid tumours

SEs: dyspnoea + diarrhoea

125
Q

What markers are used to monitor SLE flares? (2)

A

Dec Complement + Inc ESR

126
Q

How does anti-phospholipid syndrome px?

A

CLOTS: clots, livedo reticularis, obstetric comps, thrombocytopenia

127
Q

What is the mx for antiphospholipid syndrome?

A

Based on EULAR guidelines: low dose aspirin or lifelong warfarin following a VTE

128
Q

What does antiphospholipid syndrome cause a paradoxical rise of?

129
Q

What are the blood results for polymyalgia rheumatica?

A

Raised WCC/CRP/ESR + Normal CK

130
Q

Mx of Gout

A

Acute: any CIs? NSAIDs, colchicine, pred, continue the allopurinol throughout if already taking

Chronic: started 2wks after initial attack (1) Allopurinol (2) Febuxostat

Lifestyle Mods: lose weight, red high purine foods/alcohol, stop precipitating drugs

131
Q

Which drugs classically cause drug induced lupus? (3)

A

Procainamide (antiarrhythmic), Hydralazine (tx high BP), Isoniazid (anti-TB)

132
Q

How does drug induced lupus typically px?

A

Arthralgia, Myalgia, Skin/Pulmonary Involvement

133
Q

Which abs are a/w drug induced lupus?

A

Antihistone

134
Q

SLE vs DIL

A

SLE: young + female

DIL: elderly + male

135
Q

What is the adverse effect of hydroxychloroquine?

A

Bulls eye retinopathy which may result in visual loss, baseline ophthal exam, annual screening

136
Q

Mx of OA

A

Consv: wt loss, encourage exercise, local muscle strengthening, braces, insoles

Medical: para and topical NSAIDs if knee/hand, oral NSAIDs w PPI, opioids, capsaicin cream, steroid injections

Surg: if above fail refer for joint replacement

137
Q

Cardiac comps of Ehler-Danlos syndrome (3)

A

Aortic regurg, mitral valve prolapse, aortic dissection

138
Q

When should sulfasalazine be avoided? (2)

A

G6PD def + allergy to aspirin or sulphonamide

139
Q

Do you stop the pred if clinical suspicion of GCA but temporal biopsy is neg ?

A

No because skip lesions mean the result may show up as neg

140
Q

What does systemic vasc sx + hep B signs - pulm signs suggest?

A

Polyarteritis Nodosa

141
Q

What are the features of poor prognosis in RA? (7)

A

Insidious onset, poor functional status at px, extra articular features, erosions on x-ray <2yrs, HLA DR4, RF, anti-CCP abs

142
Q

Outline bone protection for pts starting steroids >65yo / prev fragility # / will be >3mnths / DEXA >-1.5

A

Co-prescribe alendronate, calcium, vit D replete

143
Q

Outline bone protection for pts starting steroids <65yo

A

Offer bone density scan w T score: >0 reassure + 0 to -1.5 repeat scan in 1-3yrs

144
Q

What is the initial mx of RA?

A

DMARD monotherapy +/- short course of bridging prednisolone

145
Q

What does hyperPTH put you at an inc risk of developing? (2)

A

Pseudogout + Renal Stones

146
Q

What is the relationship b/w calcium and eye problems?

A

HypoCa - Cataracts

HyperCa - Corneal Calcification

147
Q

Frozen Shoulder vs Polymyalgia Rheumatica

A

FS: unilateral + pain then stiffness

PR: bilateral + both sx together

148
Q

Limited cutaneous systemic sclerosis abs

A

Anti-centromere abs

149
Q

Diffuse cutaneous systemic sclerosis abs

A

Anti-Scl-70 abs

150
Q

What are the 8A’s of ank spond?

A 
Anterior Uveitis
Apical Fibrosis
Aortic Regurg
AV Node Block
Amyloidosis
Achilles Tendonitis
Arthritis Peripherally
And Cauda Equina Syndrome
151
Q

What are the clinical findings of ank spond?

A

Posture: loss of lumbar lordosis + accentuated thoracic kyphosis

Examination: red lateral flexion, forward flexion, chest expansion

152
Q

How is forward flexion tested?

A

Schober’s Test: a line is drawn 10cm above and 5cm below dimples of Venus and it should inc >5cm

153
Q

What are the crystals from joint aspiration like in gout, pseudogout, RA and OA?

A

Gout: monosodium urate, needle shaped, neg birefringent

Pseudo: ca pyrophosphate, rhomboid shaped, pos birefringent

RA: cholesterol, rhomboid shaped, neg birefringent

OA: ca phosphate, coffin lid shaped, no birefringence

154
Q

What is first line mx for ank spond?

A

Physio + NSAIDs

155
Q

What are the adverse effects of bisphosphonates? (5)

A

Acute phase response, oesophageal reactions, osteonecrosis of jaw, inc risk atypical stress #, hypoCa

156
Q

What are the adverse effects esp w alendronate? (2)

A

Oesophageal ulcers + inc risk of atypical stress # of proximal femoral shaft

157
Q

How should oral bisphosphonates be taken?

A

Taken on empty stomach >30mins before breakfast or another oral med + then remain sat/stood in that time

158
Q

What do the bloods show in antiphospholipid syndrome?

A

Raised APTT, Normal PT, Thrombocytopenia

159
Q

What is the main immunoglobulin found in breast milk?

160
Q

What does low Ca and PO4 w raised ALP make you think of?

A

Osteomalacia

161
Q

What are the possible eye signs of Marfan’s syndrome? (3)

A

Upwards lens dislocation, blue sclera, myopia

162
Q

Do Marfan’s pts have learning difficulties?

163
Q

What are chemo pts at an inc risk of?

164
Q

Mx of Pseudogout

A

Aspiration of joint to exclude septic arthritis + then NSAIDs, colchicine, steroids

165
Q

What are the adverse effects of sulfasalazine? (5)

A

Oligospermia, SJS, may colour tears

Plus resp: pneumonitis + fibrosis

Plus haem: myelosuppression, Heinz body anaemia, megaloblastic anaemia

166
Q

Is sulfasalazine safe in preg + breastfeeding?

167
Q

What should be checked before starting azathioprine? (2)

A

If the pt is on allopurinol + a TPMT test to assess risk of toxicity

168
Q

What are the adverse effects of azathioprine? (4)

A

N+V, pancreatitis, BM depression, inc risk of non-melanoma skin cancer

169
Q

Is azathioprine safe in preg + breastfeeding?

A

Yes in preg but use cautiously if breastfeeding

170
Q

What does arthritis w nail and skin changes suggest?

A

Psoriatic Arthropathy

171
Q

Which hand joint is predominantly affected in psoriatic arthropathy?

172
Q

What deformity is classically a/w psoriatic arthropathy?

A

‘Pencil-in-cup’

173
Q

Ddx for HyperCa (3)

A

If high PTH: 1° or 3° hyperparathyroidism

If low PTH: malignancy, XS calcium/vit D, paget’s, thyrotoxicosis, adrenal insufficiency

Plus drug SEs: thiazide diuretics, lithium, vit A

174
Q

How many NSAIDs must have failed before starting anti-TNFα inhibitor for ank spond?

A

Two + meets criteria for active disease on two occasions 12wks apart

175
Q

Why colchicine>NSAIDs in elderly pt on warfarin w gout?

A

Risk of life threatening GI haemorrhage

176
Q

Which score is useful for assessing hypermobility?

177
Q

What is used to tx acute flares of RA?

A

IM Steroids

178
Q

What does the presence of chondrocalcinosis on x-ray point you towards?

A

Pseudogout > Gout

179
Q

What is the z-score adjusted for?

A

Age, Gender, Ethnicity

180
Q

What is the classic triad of Behcet’s syndrome?

A

Oral ulcers, genital ulcers, ant uveitis

181
Q

What is the HLA association w Behcet’s?

182
Q

What are the four spondyloarthropathies?

A

PEAR: psoriatic, enteropathic, ank spond, reactive

183
Q

Would you find the organism in a joint aspirate of reactive arthritis?

A

No only in a septic joint

184
Q

How regularly is methotrexate taken?

185
Q

What should be co prescribed alongside methotrexate?

A

Wkly Folic Acid 5mg

186
Q

What interacts w methotrexate? (2)

A

High dose aspirin inc risk of toxicity by red excretion + trimethoprim inc risk of marrow aplasia

187
Q

What clinical feature is most specific for inflammatory back pain?

A

Improvement w activity and not relieved by rest

188
Q

What is caused by compression of the lateral cutaneous nerve of the thigh?

A

Meralgia Paraesthetica

189
Q

What should you screen for before starting biologics?

A

TB, Hep B/C, HIV

190
Q

What are the most commonly implicated bacteria preceding reactive arthritis?

A

Chlamydia Trachomatis
Salmonella Enterica
Campylobacter Jejuni

Year 5/6 (20 decks)

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